Individual
MARK WAYNNE PAULETICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RRT
Contact information
Practice address
N7, N12 & FORT DEFIANCE, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
9402 PRESERVE TRL, WOODBURY, MN 55125-7501
(715) 529-6210
Taxonomy
Speciality
Code
Description
License number
State
2279C0205X
Critical Care Registered Respiratory Therapist
Primary
3645
MN
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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